Secondary resection in patients with cholangiocarcinoma (CCA) may increase the overall survival rate, according to a new study published in the Asian Journal of Surgery.
The meta-analysis conducted by Dai and colleagues analyzed 10 publications that included a total of 1470 patients with CCA. Of all participants who underwent surgical resection, 971 had negative margins following the initial intervention, 224 achieved negative margin status after the second surgery, and 275 had remaining microscopic positive margins.
The secondary negative margin patients showcased a superior survival rate compared to the primary positive margin patients at 1, 3, and 5 years, with odds ratios (ORs) of 0.63 (95% CI, 0.41-0.97; P =.04), 0.43 (95% CI, 0.28-0.66; P <.001), and 0.28 (95% CI, 0.15-0.52; P <.001), respectively.
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“Positive bile duct margin is one of the most critical factors for poor prognosis. However, clinically, microscopic [positive margin] has a higher occurrence,” the authors said.
Furthermore, patients that achieved negative margin status after a second intervention did not report different morbidity, mortality, or complications than those who underwent only 1 surgical procedure, hence denying the increased risk for perioperative complications that some surgeons worry about and preventing them from performing a second surgery.
Both negative margin groups had similar recurrence rates (OR, 1.71, 95% CI, 0.87-3.37; P =.12). The results were also similar regarding locations for recurrence (ie, regional, distant, or both).
“Secondary resection of patients with positive bile duct margin in intraoperative frozen sections to achieve [negative margin] status is helpful to improve the overall survival rate, although the accuracy of intraoperative frozen sections needs to be improved,” the authors concluded. “We recommend secondary resection as a component of multimodal treatment, especially when the patient is in an experienced center.”
Dai YS, Hu HJ, Lv TR, Hu YF, Li FY. The effect of secondary resection in the patients with primary positive ductal margin of hilar cholangiocarcinoma: an updated meta-analysis. Asian J Surg. Published online April 11, 2022. doi:10.1016/j.asjsur.2022.03.098